The dermato-endocrinology literature does not describe three hormones governing skin appearance. It describes skin as both a target of and a factory for many hormones. Skin contains equivalents of the hypothalamo-pituitary-adrenal and hypothalamo-pituitary-thyroid axes, is acted on by multiple hormones, and itself synthesises many substances with hormone-like activity . Hormone receptors sit in epidermal and follicular keratinocytes, melanocytes, fibroblasts, sweat and sebaceous glands, endothelial cells and dermal papillae . Steroid hormones, phospholipid hormones, retinoids and nuclear receptor ligands as well as stress hormones all play roles in pilosebaceous development, sebaceous lipogenesis and hair cycling, with androgen the most extensively studied and of highest clinical significance .

Individual hormones with documented skin effects extend well past any set of three. Androgens: they stimulate growth of the sebaceous glands and increase sebum secretion, promoting acne-associated changes , and a high-glycaemic diet raises insulin secretion, which in turn is implicated . Estrogen: its decline during menopause contributes to decreased collagen production, reduced elasticity and moisture loss . Thyroid: thyroid hormone is considered one of the key regulatory hormones for skin homeostasis . Older endocrine work examined estrogen, androgen, cortisol, growth hormone and thyroid effects on skin connective tissue via serial biopsy . Growth hormone and IGF-1: in females, 17β-estradiol, DHEA, progesterone, growth hormone and IGF-I all fall significantly with age , and growth hormone's effects on skin cells are largely indirect via insulin-like growth factors . Prolactin: prolactin and its receptor are present in human sebaceous glands and prolactin stimulates sebum production .

On how much of visible appearance is hormonal at all, the largest single driver identified in the literature is not endocrine. Clinical signs of ageing are essentially influenced by extrinsic factors, especially sun exposure, with UV exposure appearing responsible for roughly 80% of visible facial ageing signs .

On the actionability implied by "balance them," evidence is weaker than the claim suggests. Studies report improvements in skin thickness, collagen content, elasticity and hydration with systemic or topical estrogen therapy, but benefits are inconsistent across studies and HRT is not currently indicated for this purpose , and that review was supported by Merz Aesthetics . The consumer "hormone balancing" category is commercially driven: brands now offer skincare for hormonal stages and supplements promising to stabilise hormones, a category colloquially called "hormone balancing" , and the trade reporting frames endocrinologists as skeptical. Hormone testing is not routine for most acne: the majority of women with acne have normal androgen levels, and hormonal testing is recommended only when acne comes with excess facial or body hair, deepening voice, or irregular periods .